What is the Scientific evidence that Ritalin may cause permanent heart damage? There are
two research articles from the prestigious St. Louis Medical School in St. Louis Missouri:
(1) Fischer, VW et al., Journal of the American Medical Association (JAMA) 1977:
238:1497 and (2) Henderson, TA et al. The American Journal of Cardiovascular Pathology
1994; 5(1):68.

These two articles provide disturbing evidence that Ritalin may cause permanent damage
to the myocardial (heart) ultra structure of humans.

Over a million young ADD/ADHD people are now taking Ritalin. How many of these young
people and their parents have been informed by their physicians that Ritalin may cause
permanent heart damage? Have the manufacturers of methylphenadate carefully investigated
the matter of possible heart damage from Ritalin? How harmful is such damage? What current
medical research is ongoing concerning this matter? Should physicians and the lay public
know more about this issue?

Are you aware that the pediatric literature, including textbooks, often recommend that
Ritalin be the first medication prescribed to young people with ADD/ADHD? Equally as
disturbing to me, because of the Board's power to regulate physician behavior, the Medical
Board of California (most members of which are not medical doctors) recently state,
"Tricyclic antidepressants are recommended only when the patient's symptoms are
resistant to stimulant (Ritalin) therapy, or stimulant therapy that is otherwise
specifically contraindicated." Adding coal to the fire, the New York Times newspaper
recently published an article about adults with ADD/ADHD which stressed the important role
of Ritalin in treatment while never mentioning that Ritalin may cause permanent heart
damage.

Why is Ritalin commonly recommended as the initial treatment medication over the
amphetamines, especially dextroamphetamine? One important reason is based on pure
emotions. The amphetamines have a bad reputation because methamphetamine is a common
street-drug. People have gone to prison on amphetamine-related charges.

The experience of some physicians, however, is that the amphetamines are in general
clinically more effective than Ritalin for the treatment of ADD/ADHD. Moreover, the
argument that Ritalin should be preferred to amphetamines is not supported by medical
science. Methylphenadate is structurally related to amphetamine, shares the abuse
potential of the amphetamines, and its pharmacological properties are essentially the same
as those of the amphetamines. Goodman & Gilman's The Pharmacological basis of
Therapeutics, 9th Ed.

The next important question is, should the initial mediation treatment of ADD/ADHD be a
stimulant or an antidepressant drug? Of course, it should be the "proper drug"
for the given individual. The "proper drug" is the one that corrects the
specific ADD/ADHD complaints of the individual. In my opinion, that drug is more often and
antidepressant than a stimulant. Let's look at the facts.

POSITIVE STATEMENTS ABOUT RITALIN:

In a few instances, Ritalin (methylphenadate) is the only medication that is effective
in an ADD/ADHD individual.

Ritalin follow-up care by physicians rarely requires electrocardiograms (ECG's) or blood
Ritalin level evaluations, both of which are expensive tests.

NEGATIVE STATEMENTS ABOUT RITALIN:

Ritalin is clearly NOT effective treatment in about 30% of children.

When Ritalin effect wares away, there very often is a sever "let-down" or
"emotional crash" and sometimes with return of violent behavior.

Ritalin rarely helps ADD/ADHD people wake easily or feel less grumpy in the morning.

Tricyclic antidepressants are effective in 80% of young ADD/ADHD people so treated.

Tricyclic antidepressants are almost always effective for 24 hours, that is, all day and
night, even when taken only once a day. Tricyclic antidepressants are not followed by a
"crash" or "let-down" on days they are taken.

Tricyclic antidepressants are not addicting.

Tricyclic antidepressants stop bed wetting associated with ADD/ADHD in about 90% of
cases.

Tricyclic antidepressants help ADD/ADHD people fall asleep more easily.

Tricyclic antidepressants do not stunt growth in children.

Tricyclic antidepressants in overdose may cause cardiac (heart) death, but Tricyclic
antidepressants in therapeutic doses have never been shown to cause "sudden
death" in children.